The HHS Supply Service Center (HHS SSC) is to serve as the Drug Distribution Center (DDC) for the Myasthenia Gravis Study (MGTX). This study is a five year randomized, single-blinded controlled trial in approximately 200 patients. The study is a randomized trial of surgery versus no surgery and the drug treatment protocol is prednisone and the same for both groups. The contract will cover a five year period from April 2006 to October 2010. The study shall consist of approximately 200 participants and 69 clinical Sites in the United States and around the globe. The study includes MG centers in South America, Europe, South Africa, Australia and the Far East. Each of the 200 participants will receive treatment for a total of 24 months. This revision is due to the change in the original scope of work which caused an increased cost of assembly of MGTX Medication Portfolios. We are now shipping out Surgical Kits, Drug Expiration Resupply Kits, New Patient Kits and Normal Drug Kits. The cost of shipping the various kits, the frequency of shipments and the cost of customs clearance to sites outside of the United States is reflected in the added shipping.